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- 저자 : ( Basavaprabhu Achappa ) (검색결과 2 건)
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( Basavaprabhu Achappa ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Symmetrical peripheral gangrene (SPG) is characterized by distal ischemic damage in two or more extremities leading to gangrene in the absence of major vaso-occlusive disease or vasculitis.We present a case of SPG in a 64 year old gentleman from South India. Case History: 64 year old gentleman, known case of hypertension,diabetes and chronic kidney disease presented with fever and cough of two days. He was febrile and pallor was present.His pulse rate was100/min, BP170/90 mmHg. Laboratory reports revealed hemoglobin of 6.3 gm%, total count 18,900 cells/cumm, platelet 70,000/cmm. His blood urea was 382 mg/dl, creatinine15.3mg/dl. He was managed with intravenous broad spectrum antibiotics and hemodialysis. He developed blackish discoloration of fi ngers and toes 4 days after hospitalization. Investigations revealed Prothrombin time of 22.8s and activated partial thromboplastin time (APTT) 121.fibrin degradation products (FDP) was elevated. Platelet count decreased to 25,000/cmm. Peripheral smear showed schistocytes. Arterial Doppler of all four limbs indicated normal fi ow. Diagnosis of Sepsis causing SPG was made.Fresh frozen plasma and platelet transfusion was administered. Surgical amputation was advised,but patient refused.He expired 10 days after hospital admission. Discussion: SPG is cutaneous marker of DIC.SPG should be suspected at fi rst sign of coldness, pallor and cyanosis of acral parts.In SPG peripheral pulses are intact as large vessels are spared from disease process.Given its rarity,treatment guidelines are a grey area and no defi nite guidelines exist.Treatment of sepsis and DIC,discontinuation of vasopressors and anticoagulation are the suggested fi rst-line measures.Mortality can reach 35% and 66% of survivors require amputation of affected limbs. Conclusion: A variety of infectious and non infectious disorders are associated with SPG.Physicians must be aware of SPG as it usually presents in an unpredictable manner in patients with sepsis.Patients who develop DIC should be closely monitored for development of SPG.
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( Rajaram Deepak Madi ),( Sathish V ),( Basavaprabhu Achappa ),( Sathish Rao ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Highly active antiretroviral therapy (HAART) is available free of cost in India as a part of our national ART programme since 2004.Early diagnosis and initiation of HAART are key components for the success of HIV control programmes. Late presentation with low baseline CD4 cell count is a strong prognostic marker for early mortality among HIV patients. The main aim of our study was to identify late presenters based on initial CD4 cell count testing. We also wanted to identify factors associated with late presentation. Methods: This retrospective hospital based study was carried out at Kasturba Medical College. The study group included 474 newly diagnosed HIV patients registered in the ART clinic of KMC between February 2012 and February2013. Subjects with CD4 T cell count below 200 cells per cubic millimetre were classifi ed as late presenters. Subjects with CD4 T cell counts less than 50 cells per cubic millimetre were termed as very late presenters. Statistical analysis was performed with SPSS software. Results: The mean age of our study population was 41.60±9.28years. Majority of our study population were males 327(69%). Median CD4 count at diagnosis was 188 cells per cubic millimetre ([IQR] 93-366 ). 208(44%) patients had WHO stage 4 disease at presentation. 251(53%) were late presenters and 223(47%) were early presenters. 47(9.9%) were very late presenters.Male gender(p=.03) and residing in rural area (p=.001) had a signifi cant positive association with late presentation. Conclusions: More than fi fty percent of patients were late presenters despite ART being available free of cost in India. Late presentation poses a signifi cant threat to the success of our national ART programme.HIV/AIDS care intervention programmes must target men and the rural population as they are vulnerable for late presentation as shown in our study.
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